Dear Further to your request under the Freedom of Information Act 2000, I am now in a position to respond as below. I have included your questions for ease of reference. 1. In which documents can we find your public health agenda for HIV – please send electronic attachments – sexual health strategy – currently in draft format – awaiting sign off. Draft action plan attached. 2. Would you please specify any HIV-specific QIPP projects you have in your local health economy? We have a task and finish group scheduled to first meet in February whose role will be to review HIV cases in Milton Keynes and further develop strategy to improve early diagnosis, improve local clinicians awareness and reduce stigma and reduce onward transmission. 3. In your local health economy what is the HIV patient journey and how is this mapped? Local patient journey. Diagnosis in either community or GUM setting. From diagnosis (in Milton Keynes) referred to GUM HIV Nurse and HIV Consultant take on care. Automatically linked into HIV social work team and counseling services. HIV operational group meets monthly to discuss any specific issues. 4. Who is responsible for commissioning HIV services? The AIDS support grant is held by Milton Keynes Council and they commission support services for people diagnosed with HIV and education services. NHS Milton Keynes commissions HIV prevention and clinical services. 5. When are HIV tenders published?? Any HIV tenders would be published following development. We do not have any HIV tenders out at the moment. 6. What are the Key Performance Indicators that commissioners apply to HIV service providers? Numbers diagnosed, stage of early diagnosis. 7. What are your local HIV prevention policies? – as above in action plan 8. What strategies do you have in place relative to HIV to diagnose the undiagnosed? Condom distribution scheme operational targeting communities with highest rates of HIV operated by STaSS (community based organization). Quick Test Clinics established in community settings targeting communities with greatest prevalence. 9. Do you have any local HIV networks - please give contact details? We have a sexual health strategy group which includes sub groups looking at HIV. 10. Are there HIV local prescribing guidelines - please send electronic copies? We keep in line with Oxford Guidance and MOBB Low Priority Statements (attached Raltegravir and Maraviroc). The Oxford list is:- Abacavir Abacavir with lamivudine (Kivexa) Abacavir with lamivudine and zidovudine (Trizivir) Amprenavir Atazanavir Darunavir Didanosine Efavirenz Emtricitabine Enfuvirtide Etravirine (TMC-25) Fosamprenavir Indinavir Lamivudine Lopinavir with Ritonavir Maraviroc Nelfinavir Nevirapine Raltegravir Ritonavir Saquinavir Stavudine Tenofovir Tenofovir with emtricitabine (Truvada) Tenofovir with emtricitabine and efavirenz (Atripla) Tipranivir Zalcitabine Zidovudine Zidovudine with lamivudine 11. Which prescribing groups that influence HIV treatment? As above, confirmed by the Milton Keynes Joint Trusts Medicines and Therapeutics Committee. 12. What are the main driver for these groups and who influences them? Clinical and cost- effectiveness; decisions influenced by clinicians, pharmacists, lay members of the above groups. I trust you find this information useful. Please do not hesitate to contact me if you require any further assistance. I have attached a copy of the Trust’s leaflet on how we deal with Freedom of Information requests, should you require any additional information about the process. Please note that any re-use of this information will be subject to the ‘Re-use of Public sector Information regulations.’ Please contact Milton Keynes PCT for further information. Kind regards, South Central Priorities Committees (Milton Keynes, Oxfordshire, Berkshire East, Berkshire West, Buckinghamshire PCTs) Policy Statement 27: Maraviroc in the management of human immunodeficiency virus type 1 (HIV-1) infection resistant to standard therapy Date of issue: October 2010 The Milton Keynes, Oxfordshire, Berkshire & Buckinghamshire Priorities Committee has considered the evidence of clinical and cost-effectiveness for maraviroc in the management of human immunodeficiency virus type 1 (HIV-1) infection resistant to standard therapy and recommends: Maraviroc may be a treatment option for treatment-experienced adults infected only with CCR5-tropic HIV1 in accordance with the BHIVA guidance AND For patients who have triple class resistance AND Can only be initiated after discussion by a group consisting of: a minimum of 3 consultants with relevant expertise, an HIV pharmacist and with virology input Maraviroc, in combination with other antiretroviral medicinal products, is licensed for treatment-experienced adult patients infected with only CCR5-tropic HIV-1 detectable virus The superiority of maraviroc compared with placebo, both given in combination with optimised background therapy (OBT) has been demonstrated in 48-week results from two phase III trials (MOTIVATE 1 and 2). The incidence of adverse effects was similar in both the maraviroc and placebo groups. The committee noted that there was no evidence to show that maraviroc was cost-effective. NOTES: 1. Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status. 2. This policy will be reviewed in the light of new evidence or guidance from NICE. South Central Priorities Committee: MOBBB, 27 October 2010 DRAFT, 64/2010 South Central Priorities Committees (Milton Keynes, Oxfordshire, Berkshire East, Berkshire West, Buckinghamshire PCTs) Policy Statement: Raltegravir in the management of human immunodeficiency virus type 1 (HIV-1) infection in adult patients Date of issue: October 2010 The Milton Keynes, Oxfordshire, Berkshire & Buckinghamshire Priorities Committee has considered the evidence of clinical and cost-effectiveness for raltegravir in the management of human immunodeficiency virus type 1 (HIV-1) infection in adult patients and made the following recommendations: 1. The use of raltegravir in combination with other antiretroviral drugs should be considered LOW PRIORITY for first line treatment of HIV-1 infection in adult patients. 2. Raltegravir in combination with other antiretroviral drugs for the treatment of HIV-1 infection in adult patients may be used • For patients who have triple class resistance AND • Only initiated after discussion by a group consisting of a minimum of 3 consultants, an HIV pharmacist and with virology input. Raltegravir is an integrase strand transfer inhibitor which inhibits HIV-1 replication and viral assembly. The licensed indication for raltegravir was extended in September 2009 to the treatment of HIV-1 in all adult patients. Studies indicate that virologic responses to raltegravir are better to those seen with placebo in heavily treated HIV-1 infected adult patients. However, the recently published STARTMRK study suggests that raltegravir is only comparable in efficacy and safety to efavirenz when used in treatment-naïve patients, although it is significantly more expensive. Two short-term studies that switched virologically stable patients with multidrug resistant HIV-1 from enfuvirtide to raltegravir showed that raltegravir was similarly effective. NOTES: 1. Exceptional circumstances may be considered where there is evidence of significant health impairment and there is also evidence of the intervention improving health status. 2. This policy will be reviewed in the light of new evidence or guidance from NICE.
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